Professional Documents
Culture Documents
Gastric Carcinoma
Gastric Carcinoma
Gastric Carcinoma
Background
Gastric carcinoma is the most common cancer in
the world after lung cancer and is a major cause of
mortality and morbidity.
Gastric Carcinoma
• Background
Adenocarcinomas account for approximately 95% of all
malignant gastric neoplasms.
Lymphomas
leiomyosarcomas
carcinoids
or sarcomas
Gastric Carcinoma
• Background
• Though a marked reduction has been observed in the
incidence of gastric carcinoma in North America and
Western Europe in the last 50 years, 5-year survival
rates are less than 20%, as most patients present late
and are unsuitable for curative, radical surgery.
Gastric Carcinoma
• Pathophysiology
• The accepted pathway involves transitions from:
• ► gastritis
►to gastric atrophy
► to metaplasia
• ► to dysplasia ►
• Pathophysiology
• ►Dietary nitrates
• ►Hypochlorhydria
• ►Helicobacter pylori
Gastric Carcinoma
• Pathophysiology
• ► Several dietary and environmental factors
may influence this pathway.
• ►Certain foods
e.g. (Starch, pickled vegetables, salted fish
and meat, smoked foods, and salt have all
been implicated in the development of
gastric carcinoma).
Gastric Carcinoma
• Cigarette smoking:
• Those who smoke more than 30 cigarettes per
day have a 5-fold increased risk of gastric
carcinoma.
Gastric Carcinoma
• Several precancerous conditions are recognized
►Chronic atrophic gastritis
Gastric Carcinoma
• Several precancerous conditions are recognized
• ► Pernicious anemia
• ► Previous partial gastrectomy
• ► Ménétrier disease
• ► Gastric dysplasia
• ► Adenomatous polyps (20% of all gastric polyps)
• ► Hereditary factors
Gastric Carcinoma
• ► In India
• Highest rate in Mumbai.
• Lowest Maharashtra state. ► by Dr. MD.;
Radhika Bobba
Gastric Carcinoma
• Mortality/Morbidity
• Sex
• Gastric carcinoma is 2 times more common in men than in
women.
Gastric Carcinoma
• Age
• Gastric carcinoma has a peak incidence in those
aged 50-70 years.
• Clinical Details
• History
• Most patients present with advanced disease because they
are often asymptomatic in the earlier stages.
Gastric Carcinoma
• Clinical Details
• History
• Common presenting features include:
epigastric pain bloating
early satiety nausea
vomiting dysphagia
anorexia weight loss (weakness, fatigue)
and upper GI bleeding:
Hematemesis, melena
iron deficiency anemia
positive results with fecal occult blood tests.
Gastric Carcinoma
• Clinical Details
• Physical examination
• Looking for signs of disease such as:
Skin and eyes (jaundice)
Lumps
Changes in the abdomen (fluid or swelling)
Swollen lymph node
• Differential diagnosis
• Because peptic ulcers and gastritis cause similar
findings, diagnosis is often delayed.
• Differential diagnosis
• Other Problems to be Considered
• Gastric lymphoma
• Gastric metastases
• Gastric varices
• Gastric polyps
Gastric Carcinoma
–
1 T1N0M0, 88%
T1N1M0, or
T2N0M0
3a T2N2M0, 35%
T3N1M0, or
T4N0M0
3b T3N2M0 35%
4 T4N1-3M0, 5%
Gastric Carcinoma
• Lab examination
• Perform blood tests including
• full blood count determination
• Endoscopy.
• Biopsy samples obtained during endoscopy.
• Fiberoptic endoscopy or a double-contrast study
of the upper GI tract.
• CT scan
• MRI
• Ultrasonography (US)
Gastric Carcinoma
• Treatment
• Neoadjuvant therapy
• Curative surgery
• Adjuvant therapy
• Palliative surgery
• Chemotherapy
• Radiation therapy
• Biological therapy (natural substances)